* This information was gathered by directly speaking with surgeons, families and individuals who have already had surgery, and through personal research including attending surgical conferences directly related to Microtia ear reconstruction. The remaining information has come from noted sources.
What is the youngest age a child can have Medpor?
Three years of age.
How many surgeries are needed for a Medpor ear to be reconstructed?
Just 1 surgery, maybe a second surgery would be needed to make adjustments to the ear lobe.
How much do you have to weigh for Medpor surgery?
You have to be at least 28 lbs.
Can I give my child my ear? No.
If a surgeon were to transplant your ear on to your child’s body, the ear would quickly become rejected. The body would recognize “your” ear as a foreign body and begin attacking it immediately and the ear would be rejected and die. God knows we all wish we could give our children our own ears. If things were only this easy.
What could cause Medpor surgery to be delayed?
Medpor surgery can be delayed for a couple of reasons: fever or an immune system attack such as a cold, flu, other virus or sickness. Also, immunodeficiency problems such as a problem with the kidneys or any other organs. Again, if a child is below the weight minimum, this could delay the surgery.
How do surgeons know how to make an ear a certain size?
At birth, a child’s ear is 66% of its adult size. At three years of age, an ear is 85% the size of an adult ear. At six years of age, an ear is 95% the size of an adult ear. An ear’s average “normal” height is 5.5-6.5cm. When reconstructing a Medpor ear, surgeons will tend to make the newly reconstructed ear ever so slightly larger in size, .5mm to be exact. This allows for the child’s biological ear to catch up to the Medpor ear since Medpor ears do not grow like Rib Graft ears do. The difference in size is hardly noticeable. Surgeons will also take the size of the parent’s ears into account as well if the child is biological to help guesstimate what the size of the ear may be in the future.
Will a Medpor ear continue to grow? No.
The size that the ear is reconstructed at will remain the same size for the rest of the patient’s life or until replacement. The only part of the ear that may change in time as the body ages, is the ear lobe. Even though a Medpor ear will not sag, the ear lobe will, especially if the ear lobe is the patients own biological ear lobe. The ear lob is just skin and as our ear lobs tend to sag over time, so with the ear lobe of a Medpor ear. So, nothing should look too different with age. The two ear lobes will most-likely age together.
Does a Medpor ear heal, feel pain or bleed like a biological ear? Yes.
Although the internal Medpor framework of the ear is synthetic, the skin grafted layers of skin over the framework still have all of their nerve endings and blood vessels in tact. In fact, since the synthetic material of the Medpor framework is porous, the ear becomes vascularized allowing the ear to heal if bitten or cut, feel pain or sensitivity to the touch, and bleed.
Can a Medpor ear fracture or become damaged?
Of course, there is always a chance of a fracture happening or a newly reconstructed ear becoming damaged (such as an exposure)…just as any part of the body could break or become damaged. Today, it is unlikely that a Medpor ear will fracture or become damaged as Medpor ears are now made differently than they were prior to 1995. Over the years, Dr. John Reinisch and Dr. Sheryl Lewin’s techniques have changed. Dr. Reinisch used to form the “arch” or “helix” of the framework of the ear by himself in the OR. Today, the Medpor framework now comes pre-made with the arch already formed. Also, two layers of skin are now used to cover the ear helping to add extra support to the ear, preventing exposures and allowing the ear to heal better. These changes alone have cut down on the possibility of damage to Medpor ears. Otherwise, patients who have Medpor surgery who have been hit in the ear by a door, a ball, or kicked, etc…have all healed just fine with no fractures. Again, if a fracture does happen or an exposure, the ear can be repaired.
Please see the following letter from Dr. John Reinisch:
Since1996 when I redesigned the current Medpor implant, we have only had a couple of fractures of the implant. We have kids participate in all sports including football, soccer, gymnastics and Judo with out problems. Injury to the ear causes swelling, but the ear heals if contused or cut.
Exposures in about 4% of cases. It is usually seen in the first few weeks after surgery. Most of these can be repaired without changing the implant It is extremely rare to see an exposure after the initial ear surgery has healed. Exposure occurs when the soft tissue over the implant is not healthy and does not heal.
Fortunately most exposures are small and do not require replacement of the implant. In the rare cases where the exposure is large or has been present for several months, we will replace the implant.
We hear about sudden swelling of the ear each summer (about 10 cases each summer). I assume that these are caused by mosquito bites. I used to place kids on antibiotics when this occurred, but now don’t worry about the ear and they seem to recover in a couple of days without antibiotics. I think that kids don’t have as fine a sensation in their new ear as their normal ear, and therefore are not as aware of being bitten by a mosquito sitting on their new ear. I suggest using a daily insect repellant cream to the ear in the summer months to prevent bites from happening.
John Reinisch MD
Director, Craniofacial and Pediatric
Cedars-Sinai Medical Center
250 South Robertson Boulevard
Beverly Hills, CA 90211
Note: 10 years ago or more, exposures in Medpor ears happened 44% of the time. Today, exposures happen less than 5% of the time due to the reinforced section of the arch area of the Medpor framework and the extra skin flap used in the skin grafting stage (bi-layered). This was discussed in a panel discussion called “Controversies in Ear Reconstruction” that I attended in September 2011 at the American Society for Plastic Surgeons conference in Denver, CO. When someone today tells you that Medpor ears fracture all the time, this is no longer true as that individual may not have the latest information. Again, technology and technique are constantly changing and improving.
If a Medpor ear is fractured, can it be fixed? Yes.
In fact, if a Medpor ear has been fractured, a small incision can be made behind the ear where the complete synthetic framework can be removed, repaired and re-inserted or an entire new framework can be replaced. The skin of the ear remains in tact and is utilized again without having to have more skin grafts used.
The skill and expertise to do this has not yet been mastered by all Medpor surgeons. It is very important to go to a Medpor surgeon who has performed hundreds of procedures or one that can show you pictures of having done this successfully.
Can a Medpor ear become infected? Yes.
A Medpor ear can become infected. However, this usually happens following surgery (just as a Rib Graft ear may become infected). Many things could cause an infection such as: the ear not healing properly in the first place, an infection from a bandage or water, a cut to the ear, etc… However, today these risks are controlled by careful protocols in the OR during surgery and also through follow up visits during post op appointments where the ear is checked on by the surgeon often during the healing stages.
Can a Medpor ear die from necrosis? Yes.
It is possible that a Medpor ear can die or be “rejected” by the patient due to skin necrosis (death of the skin). This can happen if the skin graft piece is too thin or not thick enough where there is not enough of a blood supply to keep it healthy and to have it heal appropriately. This same concern can also happen with a Rib Graft ear, or any part of the body where a skin transplant has been made. It is very important to go to experienced surgeons who have often become specialized or have developed an expertise in Microtia reconstruction. If you select an experienced surgeon, this rarely happens today. There is always a chance for any surgery that this will happen or that infection will occur.
If a Medpor ear becomes infected can it be cured? Yes.
In fact, if a Medpor ear is infected, a small incision can be made behind the ear where the synthetic framework can be removed. The infection site of the framework is then scraped and cleaned and then soaked in an antibacterial solution. The treated framework is then reinserted back into the already formed skin of the ear and stitched back up again. Another skin graft is not needed.
The skill and expertise to do this may not be performed by all Medpor surgeons. It is very important to go to a Medpor surgeon who has performed hundreds of procedures or one that can show you pictures of having done this, successfully.
Where is the skin graft taken for the Medpor ear?
There are two layers of skin grafts taken for the reconstruction of a Medpor ear. The first layer is a highly vascularized layer called the tempero-parietal fascia skin flap (comes from directly behind the ear where no hair grows) and the second skin graft comes from the groin area where no hair grows (sometimes on the upper leg area just above the groin where no hair is present). This second skin graft layer from the groin is the skin used to completely cover the ear before it is sewn onto the head. This skin will tan and match better in color to the face and look more like the other non-microtic ear color. This skin also seems to heal quite nicely with less visible scaring. This also has to do with the surgeon’s technique. Years ago, the ears looked more “white” in color or a bit plastic in appearance. Today, the ears match nicely.
The area in which the skin is taken for a skin graft may vary from surgeon to surgeon based on their technique. In the past, the skin grafts have also been taken from the inner part of the upper arm and the buttocks.
Are Medpor ears flexible? Yes.
In fact, you can bend and pull on a Medpor ear just the same as a biological ear. A medpor ear will of course feel stiffer than a biological ear because the Medpor framework is thinker. However, you can not tell a difference in thickness when looking at the ear(s).
Does it hurt to sleep on a Medpor ear? No.
It does not hurt. However, some, not all patients, may experience some discomfort when lying on their ear at first. This does get better in time and you get use to it. Some patients may experience an achy feeling if wearing head phones to listen to music with. * I happen to experience an achy feeling when I wear head phones and I have two biologically in tact ears. I believe some individuals are more sensitive than others whether you have had surgery or not. This is something that is a minimal issue.
What happens if a Medpor ear gets sun burned or burned by the curling iron?
The skin will burn and peel just like a biological ear would. The ear will then heal with the skin sloughing off just like any other sun burnt or lightly burned part of the body. However, if the ear experiences severe burns, it depends on the amount of damage. The surgeon would have to take a look at the ear in order to determine if the ear can simply be patched with another piece of a skin graft, which is most-likely what would be done. Even a Rib Graft ear or biological ear can be badly burned and suffer some disfigurement depending on the severity of the burn and or accident an individual would be involved in.
Will a Medpor ear grow hair on it? Yes and no, but ever so slightly.
As mentioned above, surgical technique and surgeon technique is constantly improving. Today, the skin graft areas selected for the skin over the ear do not grow hair. If any hair is visible, it is similar to lanugo or peach fuzz found on babies at birth. Some patients shave the ear every six months or so, if needed (this was years ago prior to surgeon technique changing). Again, the skin grafts used to cover the ears today often times do not grow much hair. It has even been known that the surgeon will try removing some of the hair follicles in the skin graft, helping prevent any hair growth on the ear in general. This again depends on the expertise of the Medpor surgeon.
How do you remove hair that may grow on the Mepdor ear?
Following surgery, the surgeon can laser the Medpor ear in one of the post op appointments. It is strongly suggested to have a surgeon laser the hair and not by beauty laser consultant or even a dermatologist. The surgeon who reconstructed the new ear knows that ear best. If you are too far to travel back to the surgeon who reconstructed the ear, ask for a referral to someone they may know closer to you that the surgeon can trust with the new ear.
Will Medpor surgery leave a large scar on the scalp? No.
A 5mm incision is made under the scalp where the tempero-parietal fascia skin flap is removed. This same incision is stitched up when the ear is sewn on the head.
Will hair grow back where the scalp scar is?
There is no scar on the scalp. The hair that has always grown on the scalp remains untouched and continues to grow normally. Also, no hair follicles were harmed on the scalp as the skin graft was not selected from the “in hair” area on the scalp. The skin graft selected came from directly behind the ear where no hair grows.
Will there be any numbness on the scalp where the incision was made for the Medpor ear?
There is no scar on the scalp, so there will be no experience with scalp numbness.
Will a Medpor ear come off? No.
A Medpor ear is attached to the head just as a Rib Graft ear is…both are sewn on and both do not come off. A prosthetic ear can be removed. A Medpor ear is not a prosthetic ear. A Medpor ear becomes a living part of the body as the skin covering the Medpor implant becomes vascularized feeling pain, bleed, heal, and is sensitive to touch, etc…
Can someone with a Medpor ear play sports?
This question has come up again and again through our group. So, I asked both Dr. Reinisch and Dr. Lewin and below are their answers:
I have read through many conversations from parents who are worried that if they choose Medpor that the ear(s) will fracture, break or come off if their child is involved with sports. So I asked Dr. Reinisch and Dr. Lewin about sports such… as soccer, volleyball, baseball, football, martial arts, and I think you get the point.
Below is Dr. Reinisch’s response to my question:
“I have performed Medpor for 20 years. Most of my patients are boys and most are under 5 years old. Even if one wanted to restrict activity, it is unlikely that a parent could actually prevent a normally active child from occasionally injuring their ear. I fully expected to see more problems related to injuries, but have been pleasantly surprised that we don’t. Most children seem to do fine. I don’t see a stream of patients coming back for repairs secondary to trauma. For this reason, I have never restricted a child from sports. We rarely see late problems with our Medpor ears, so I think it is reasonable to assume that the reconstructed ear tolerates trauma well. One of my patients is a karate champion in Georgia and many play soccer.”
Below Dr. Lewin’s response to my question:
“Any child can experience trauma to their ear or any other body part regardless of reconstruction. It isn’t often that a child or an adult gets hit… directly in the ear when compared to other parts of the body such as broken arms, legs, noses and torn tendons/ligaments. If playing certain sports that require protective gear the gear often suits its purpose and protects during the sports. It is suggested that children steer clear of volatile sports or direct contact sports such as boxing or ultimate fighting of some sort.”
Dr. Lewin has lots of patients who play soccer, baseball, football, etc…and no one has had any problems with their Medpor ears. Also, Dr. Reinisch has a patient (who’s mom is one of our group members) who had medpor with Dr. Reinisch close to over fifteen years ago and he is a champion at martial arts. He has never had any damage to his ear. Hope this helps everyone.
Can Medpor and Atresia repair (canalplasty) be performed together? Yes.
First of all, canalplasty can be performed before Medpor, during Medpor, and after Medpor. However, for performing canalplsty following Medpor, it is very important that you find a surgeon who feels comfortable doing this. A surgeon who is not too familiar with a Medpor ear could damage the ear beyond repair causing the ear to have to be reconstructed again with another skin graft for patch work and could fracture the framework to where the implant itself would have to be replaced again. As for having Medpor and canalplasty performed at the same time, yes, this surgery does exist. It is referred to as the “All in One” surgery or “Medpor CAM” procedure = combined Atresia Microtia. Both, Dr. John Reinisch and Dr. Joseph Roberson have performed over 60 patient (combined) surgeries since doing the first combined procedure in January 2008.
Can a Medpor ear be reconstructed? Yes.
A Medpor ear can be reconstructed if for some reason it was damaged beyond repair. It is a nice option to know that an ear can be reconstructed if something goes wrong or were to happen to the ear in the future, say involved in an accident. A Rib Graft ear can not be reconstructed if damaged beyond repair, mainly due to the scar tissue from the original Rib Graft surgery. There may be too much scar tissue present to be able to re attach an ear to through the Rib Graft technique. Remember, Rib Graft involves inserting the ear into a skin pocket of the skull and then suctioning the ear tight so it can heal. If there is no “good” or workable skin left in this ear by the ear that has not already been used, Rib Graft can not be an option to make another ear in this same region. However, a Medpor ear can be an option for another ear to replace a damaged Rib Graft ear as the Medpor ear does not require a skin pocket and is just sewn directly on to the skull.
In the future, can a Medpor implant be removed to insert actual harvested “ear” cartilage? Yes.
It is possible that in the future a synthetic framework from a Medpor ear be removed and actual “ear” cartilage be re-inserted into the ear. Since a Medpor framework can already be removed and re-inserted into the same already reconstructed skin graft, it is possible that an actual piece of ear carticlate can take its place. Now, this has not been done yet…there is no sound evidence behind doing this. However, anything is possible in the future and a Medpor ear allows you to be flexible with inserts.
– Always do your research on all surgical techniques that exist today and that are on the horizon.
– Always seek more than a couple of medical opinions.
– Just because you have found a surgeon who is down the road from you, may not mean that surgeon will yield a successful surgery.
– Don’t be afraid of insurance coverage. There are ways to appeal and or fund raise. There are also organizations who may be able to help you with surgery. * See my lists of helpful resources and helpful financial resources.
– Do attend a surgical conference if you can so that you can learn as much as you can about surgery.
– Don’t be afraid to ask questions or to ask your surgeon to help you clarify something. Many times, if you are not an adult having surgery, these are our children we are talking about here and we advocate for them as best as we can.
– Nothing man made is ever perfect. However, Medpor ears are darn beautiful and amazingly near perfect. They look almost exactly like the biological ear, match wise. The detail is great. Also, many of us would be so happy to have an ear, even if the ear lobe was slightly off or had a little bit of a dimple in it from an incision when compared to having no ear at all. So, even though you may go into surgery expecting a “perfect” ear, perfect is what you will never get…so please do not set yourself up for failure. However, you will be very pleased with a new Medpor ear.
– The Medpor surgical technique is a wonderful surgical option for ear reconstruction. What is most important is that you choose a surgeon who is experienced or who has chosen to become specialized in Microtia repair as not every surgeon who practices Medpor for ear reconstruction yields the most successful results, makes the nicest looking ears, or can show the best quality of work. Please do your research and ask to see lots of “before” and “after” pictures, including ask to speak with past patients so you can see for yourself if you are satisfied with a surgeon’s work. Some surgeons have mastered certain skills that can make the world of a difference in the way the ear looks, how the ear is shaped, how the ear heals (scaring wise), how the color of the skin selected for the skin graft matches in color to the face and other ear, and the quality of the ear depending on how the ear holds up over the years. When it comes to yourself and especially your child, please make sure you have learned as much as you can about the surgery and do seek multiple opinions so you can make the best decision.